DR10.7 | Inguinal Bubo Syndromic Management — Summary & Reflection

KEY TAKEAWAYS

An inguinal bubo in a sexually active adult is a NACO syndromic category whose two principal causes you must recognise: lymphogranuloma venereum (Chlamydia trachomatis serovars L1-L3 — invasive, causing granulomatous lymphadenitis, the groove sign, matted tender nodes, and sometimes proctocolitis) and donovanosis (Klebsiella granulomatis — a beefy-red friable bleeding ulcer with a pseudobubo and intracellular Donovan bodies on tissue smear). Build a differential that also includes chancroid, syphilis, pyogenic adenitis, and plague, and confirm donovanosis at the point of care with a Giemsa tissue crush smear while treating syndromically at first contact. Manage with NACO Kit 6 (yellow, per current NACO guidance): doxycycline 100 mg BD as first-line (≥21 days for LGV; until healed for donovanosis), erythromycin as an alternative, and azithromycin weekly as a donovanosis alternative. Aspirate — never incise — a fluctuant bubo, and complete care with partner treatment, condom promotion, an HIV-testing offer, counselling, follow-up, and referral when complicated.

REFLECT

Imagine you are the only doctor at a rural CHC and a patient presents with a tender groin swelling and a vaguely remembered genital sore. Reflect on how you would reason from presentation to syndromic treatment without a laboratory, and what you would do to ensure the partner is also treated when the patient is reluctant to disclose the relationship. How would you balance the urgency of treating at first contact against the temptation to wait for confirmation you cannot easily obtain — and what would you document to protect both the patient and yourself?